1 – Please write your service instructions on this envelope

2 – Lock your car, attach keys to this form (insert both in a sealed envelope)

3 – Sign at bottom and drop in our mail slot

 

Name ____________________________________________________

Address ______________________________ City ________________

Zip Code ________________ Mileage __________________________

Bus. Phone __________________ Home Phone ___________________

Year ________ Make _________________ Model _________________

License Number _________________________ Color ______________

 

Check/repair the following:

	Lubrication Service		Clutch
	Oil & Filter		Brake
	Air Cleaner		Alignment
	Transmission Oil		Wheel Bearings
	Differential Oil		Balance Wheels
	Oil Leaks		Rotate Tires
	Engine Tune-up		Steering & Shocks
	Muffler		Lights
	Exhaust System		Air Conditioning
	Emission System		Flush Radiator
	State Inspection		Body Damage
			Undercoat

 

Comments:

 

 

Do you want old parts (circle one)?    Yes    No

 

Not responsible for any personal items left in vehicle. I hereby authorize the above repair work to be done along with the necessary materials. You and your employees may operate the above vehicle for purposes of testing, inspection or delivery at my risk. An expressed mechanic’s lien is acknowledged on the above vehicle to secure the amount of repairs thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control.

 

Signed X ___________________________________________________